Battle for Britain: Resisting the Privatization of the NHS and the Loss of 100,000 Jobs

By Andy Worthington

On Saturday, I published an article, Battle for Britain: Fighting the Coalition Government’s Vile Ideology — and Praise for UK Uncut, in which I summarized many facets of the coalition government’s “unprecedented assault on almost every aspect of British society — hard-pressed middle class and working class people, students, schoolchildren, the working poor, the unemployed and the disabled; everyone, in fact, except the rich and the super-rich.” I also noted how, “[d]riven by a repusive ideological desire to smash the British state, and to privatize whatever was not privatized under Margaret Thatcher, John Major, Tony Blair and Gordon Brown, the government was “ferociously pursuing the biggest ever hatchet job on the British state on the basis of economic necessity, counting on the sloth and indifference of the public to disguise their true intentions, and to prevent anyone from scrutinizing how those responsible for the financial crisis — the banking sector, and the corporations committed to wholesale tax avoidance — are not being held accountable.”

In that article, in which I also wondered how, or if a powerful coalition opposed to the cuts would emerge (and praised the campaigning of UK Uncut, which has honed in specifically on the banks and tax avoiders), I mentioned that I would address, in a separate article, the government’s plans to privatize the NHS by stealth, and am pleased to do so below.

Of all the wretched plans put forward by a government that combines arrogance and stupidity to an alarming degree, the biggest gamble is the privatization by stealth of the NHS, which may well alienate voters in huge numbers (as well as endangering the health of the health service) as the effects of health secretary Andrew Lansley’s deranged plans begin to bite. As the Guardian explained when the health and social care bill was unveiled on January 19, the aim is “to abolish all of England’s 152 primary care trusts,” and ten strategic health authorities, “which currently plan services and decide how money should be spent,” and to transfer all of these decisions to GPs, who will form consortia “which will take control of 80% of the NHS budget [£80 bn a year], buying services from providers in the public, private and charity sectors.”

The privatization of the NHS

No one outside the government appears to like the plans. As the Guardian reported on February 4, in an article entitled, “Is anyone in favour of Andrew Lansley’s NHS reforms?” Lansley’s plans to transform the NHS in England “have united in opposition doctors, health thinktanks (and the right-of-centre thinktank Civitas), unions representing the 1.4m-strong NHS workforce, health academics, MPs on the health select committee, the NHS’s major employers, and patients’ representatives,” and “Even David Cameron’s brother-in-law, an NHS cardiologist, thinks the government has got it wrong,” as the Prime Minister admitted the week before. As another article on February 1 explained:

We might expect Unison boss Dave Prentis to claim that “this titanic reorganisation threatens to sink the NHS”. But not the British Medical Journal to run an editorial headlined “Dr Lansley’s monster”, branding the changes “mad” and its chief architect “deluded”. Or the King’s Fund health thinktank’s famously forensic economist John Appleby to in effect accuse Lansley and David Cameron of exaggerating the NHS’s quality of care relative to France to help justify their colossally risky experiment.

As the Guardian explained bluntly, critics are convinced that, because the GPs’ consortia will be “able to opt for treatment from ‘any willing provider’ –- NHS, private healthcare or charity” –- the result will be nothing less than the privatisation of the NHS (see this article by Polly Toynbee for examples of how it will work, and this article by Oliver Huitson on Open Democracy). The Guardian provided criticism from GPs, Midwives, Nurses, Hospital doctors, Public health experts and NHS managers — all of which are worth reading — but what particularly impressed me was a column by Dr. Kailash Chand OBE, a GP who chairs Tameside and Glossop NHS, who, on January 31, under the heading, “NHS reforms are this government’s poll tax,” spelled out both the bigger picture and the problems with the small print. Dr. Chand wrote:

This proposed bill is the biggest challenge to core NHS values. The coalition is planning to turn the NHS over to a plethora of private companies who either commission or provide services, or both. The government’s dismantling of the National Health Service has a genealogy running from Margaret Thatcher through the years of Tony Blair and Gordon Brown to David Cameron’s coalition. The last Labour government laid the groundwork for everything the coalition is planning to do to the NHS. Market structures, foundation trusts, GP consortia and the introduction of private corporations into commissioning were all products of the ill-conceived Labour vision of “public service reform”.

The idea that competition breeds excellence and market forces make everything more efficient is a myth anyway. Two successive governments have now shown that simulating a market ethos in the NHS might bring blips of success, but it carries the potentially fatal consequence of producing erratic behaviour from otherwise sensible people. […]

Why do I have serious misgivings? Apart from the threat of piecemeal privatisation, there seems to be no clarification on what happens if GPs run out of money before the end of the financial year. What happens if GPs will not refer patients to the hospital of their choice because of cost? If a patient is referred to the cheapest provider on financial consideration, will he/she get the best treatment? If hospitals cannot attract “business” from GPs, will they be privatised? How will the conflict of GPs — who are both providers and purchasers — be managed, and what impact might this have on their local hospital?

The legislation proposes a market-based approach that must involve competition between “any willing providers”. This supposes that GP consortia would be able to favour their local provider and build excellent local services. The consortia of GPs established to spend £80 billion on commissioning will become rationing committees, choosing which services should be cut and which groups of patients should lose out. Patients’ lives are about to rest on the bottom line of the GP’s budget.

There is likely to be intolerable pressure on clinicians to dilute their needs-led approach to patient care and instead consider all manner of economic and other factors. Patients should be worried, because GP practices are not set up to do this. They are clinical enterprises, not businesses. Saying “no” to patients does not come easily to GPs.

At the heart of Lansley’s agenda may be the complete privatisation of the NHS — a process that has deep roots in Thatcherite ideology. We may be witnessing the end of the NHS as a publicly provided, publicly financed body. We are moving away from the traditional health service to one ruled by bogus choice, competition, market forces and supplier diversity. And in this sort of health service the chronically and terminally ill, the mentally ill, those from lower socio-economic groups and the elderly are likely to lose out.

Job losses

On jobs, Lansley’s plans aim “to cull more than 24,000 management staff to reduce bureaucracy,” but while this may please those who have seen the NHS as being too dominated by managers, it is still a huge job loss, and it also disguises the fact that, despite all kinds of promises to protect the NHS, the government is not only privatizing by stealth, but is also happy to see ten percent of the total NHS workforce — at least 100,000 people — put out of work.

This has not been widely reported in the mainstream media, although the Daily Mail managed to note on November 12 that “Tens of thousands of doctors and nurses are facing the axe despite Government promises to protect the NHS from cuts,” and that “Almost 100,000 hospital posts could be at risk across the country, the vast majority of them frontline staff who are caring for patients,” and on February 3 the BBC reported that “Barts and The London NHS Trust is to cut 635 jobs over the next two years as it tries to reduce costs,” explaining that this will involve “200 compulsory job losses” and that “Nearly 10% of nursing posts and 100 beds will go and there will be 290 fewer corporate and back-office roles.”

It is also clear that, behind the headlines, ten percent cuts across the board are taking place everywhere, with large numbers of job losses expected by the end of the financial year. As with much of the government’s butchery, however, it appears that no one will realize until the damage has been done, and an NHS insider I spoke to noted ruefully that it has failed to cause ripples within the unions, as those who still have jobs are content to keep their heads down and hope that they will remain safe.

Will the destruction of the NHS be a rallying call for protestors, as Stuart Weir urged on Open Democracy on Thursday, noting the results of polls showing that it was by “far and away the most popular institution in the country”? Or are we condemned, by the selfishness and indolence of our culture, to watch the Egyptian people rise up in revolt, but do nothing ourselves? As Weir noted:

Lately we have had protests over tuition fees, the abolition of education maintenance allowances, library closures and the sale of forests — the middle class influence seems evident to me.

What astonishes and alarms me is that there is as yet no sign of major protest over the government’s plans for the NHS. The brazen breaking of Liberal Democrat promises to combat and remove tuition fees inspired the rage that fuelled the student protests. Yet … the Conservatives are incubating as great a betrayal over the NHS, an issue which deeply affects the whole population, without creating a similar reaction.

It’s a long time until the major TUC rally and march in London on March 26, entitled, “March for the Alternative: Jobs, Growth, Justice,” but maybe that will be the opportunity for protestors against all the government’s outrageous cuts and “scorched earth” reworkings of existing bodies, as with the NHS, to come together to form a new coalition, and a new way of thinking. The Labour party clearly hopes to galvanize support, as it was revealed on Thursday that Ed Miliband is expected to speak at the rally’s conclusion in Hyde Park, but I’m not convinced, given the scale of the challenges we face as a nation, that the Labour party has the answers — for a variety of reasons, not least the fact that some of the coalition government’s cuts are following up on moves initiated by the Labour government.

What we need, difficult though it may be to imagine, is a revolutionary new political movement that puts people, jobs and “the common good” before ideology and an ingrained servitude to big business and the City, and a truly radical vision of how to achieve that, and not, as we have at the moment, a coalition government committed to making as many people as miserable as possible, and with no clue whatsoever about how to create new jobs, and an opposition party that lacks vision.